The American Physical Therapy Association 2020 Vision Statement suggests that “physical therapists and physical therapist assistants will render evidence‐based services throughout the continuum of care and improve quality of life for our society.” Make sense right?? I know if I am having anything medical done, I would like “evidence” to be part of the thought process from the clinician rendering the services. Despite how much sense this makes, you would be very surprised to find out how many physical therapists are NOT using evidence in their clinical practice, but instead, just keep using the same old tired techniques. There has been studies done that show that 30‐40% of patients do not receive care according to current scientific evidence and about 20‐25% of care provided is not needed or is potentially harmful. Crazy, right??
So, what is Evidence Based Practice? Quite simply, it is using well researched, peer reviewed studies to shape your clinical practice. The goal is to have a standard approach to the evaluation and treatment of a variety of conditions to optimize the quality of patient care. A physical therapy practice that is using Evidence Based Practice will have therapists that” integrate clinical experience with conscientious, explicit and judicious use of research evidence in order to make clearly informed decisions to help maximize and optimize patient well‐being.” If you are being treated in a facility that uses Evidence Based Practice, you should see very little differentiation amongst the approach of the therapists…if you are seen by a different therapist, the treatment should remain very consistent as should the overall philosophy of treatment. The hallmark of a physical therapy office that is utilizing Evidence Based Practice is going to be better patient outcomes, but despite the abundance of good clinical studies to shape a practice, the vast majority of physical therapy offices still do not used an evidence based approach.
The term Evidence Based Practice has really become a buzzword…people tout that they do it, but the evidence in studies shows the opposite. One of the biggest problems that physical therapy faces as a profession is the very wide variability of practice patterns between physical therapists…and in most cases, physical therapists that work in the same office are using completely opposite techniques.
What confuses many people that get treatment for places that are not using evidence based treatment is that they do “get better” with a variety of treatments, but is this because the treatent was effective, or, was it because you just “got better” while getting a variety of treatments that actually didn’t have any effect at all? It would makes sense that there should really be just one way to treat a specific injury, right??
So what are some of the defining characteristics of an Evidence Based Practice :
Using the best research evidence: This means using relevant patient‐centered clinical research to help in the diagnosis and differentiation of injuries as well as the efficacy and safety of therapeutic, rehabilitation, and preventive strategies. The most updated clinical research suggests new ways to diagnose pathology and approach treatments. It also can often invalidate older ways of diagnosis and methods of treatment and replace them with more powerful, valid, or successful methods. At Blue Hills Sports & Spine we are very careful that everything we do is based on the latest, best clinical research.
Using clinical expertise: This means the ability to use clinical skills and past experience to rapidly identify each patient’s unique diagnosis, their individual risks and benefits associated with potential interventions, while skillfully integrating their personal values and expectations. Clinical expertise is something that is developed (of course), but a good center will quickly bring new clinicians up to the speed of older clinicians through clinical shadowing, teaching and good clinical discussion. At Blue Hills Sports & Spine, we ensure that every clinician is trained in the same techniques and in the same way. We have an approach and a philosophy to everything we do and we make sure that all our clinicians share that expertise.
How is Evidence Based Practice used at Blue Hills Sports & Spine Rehabilitation?
• When we do our initial evaluations on patients, we are making sure that we evaluate all the surrounding joints…the whole structure of the person. Although the pain is in one area, the cause could be someplace else. We always “treat the cause, not just the symptoms”.
• When we develop our treatment program, it is based on our findings from our comprehensive evaluation…we ask ourselves “why” for each treatment we decide to use…is this “the best, most effective means of treatment for this problem”?
• We measure…and then we re-measure. Many times a few treatment sessions starts to uncover an underlying problem that wasn’t evident during the initial treatment. It’s important to frequently re-assess to make sure that we are making the best use of our treatment and that patients are responding to this treatment.
• We take your needs into consideration. When we are establishing our treatment programs, we are incorporating YOUR goals, not just ours. Our goals may be to improve your range of motion, increase your strength, maximize your flexibility…but these are just benchmarks. Ultimately the most important goal is to help you get back to what you want to do and we have to use the latest in research and techniques to accomplish this.
• We measure ourselves so we can keep improving. Not all physical therapy offices utilize outcome studies…we do. We do initiate outcome studies on 100% of our patients and we measure and track improved function, symptom relief and patient satisfaction. We subscribe to a national data base that not only allows us to track how we are doing, but compare ourselves to other physical therapy practices from around the country…and we do well.
At Blue Hills Sports & Spine we are proud to be a group of offices that all subscribe to the philosophy of Evidence Based Practice…it’s why you can be seen by any of our therapists, at any of our locations and get the same, quality treatment. Without evidence, you are just guessing!
Michael Vacon, PT
Proud to be Evidence Based